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A Decline in intraoperative Renal Near Infrared Spectroscopy is associated with Adverse Outcomes in Children following Cardiac Surgery #MMPMID26914625
Gist KM; Kaufman J; da Cruz EM; Friesen RH; Crumback SL; Linders M; Edelstein C; Altmann C; Palmer C; Jalal D; Faubel S
Pediatr Crit Care Med 2016[Apr]; 17 (4): 342-9 PMID26914625show ga
Objective: Renal near infrared spectroscopy (NIRS) is known to be predictive of acute kidney injury (AKI) in children following cardiac surgery using a series of complex equations and area under the curve. This study was performed to determine if a ? 20% reduction in renal NIRS for 20 consecutive minutes intra-operatively or within the first 24 post-operative hours is associated with 1) AKI, 2) increased AKI biomarkers, or 3) other adverse clinical outcomes in children following cardiac surgery. Design: Prospective single center observational study Setting: Pediatric cardiac intensive care unit Patients: Children less than or equal to age 4 years who underwent cardiac surgery with the use of cardiopulmonary bypass during the study period (June 2011 to July 2012). Interventions: None Measurements and Main Results: A reduction in NIRS was not associated with AKI. 9/12 (75%) of patients with a reduction in renal NIRS did not develop AKI. The remaining 3 patients had mild AKI (pRIFLE-R). A reduction in renal NIRS was associated with the following adverse clinical outcomes: 1) a longer duration of mechanical ventilation (p = 0.05), 2) longer intensive care length of stay (p = 0.05), and 3) longer hospital length of stay (p < 0.01). A decline in renal NIRS in combination with an increase in serum IL-6 and serum IL-8 was associated with a longer intensive care length of stay, and the addition of urine IL-18 to this was associated with a longer hospital length of stay. Conclusions: In this cohort, the rate of AKI was much lower than anticipated thereby limiting the evaluation of a reduction in renal NIRS as a predictor of AKI. A ? 20% reduction in renal NIRS was significantly associated with adverse outcomes in children following cardiac surgery. The addition of specific biomarkers to the model was predictive of worse outcomes in these patients. Thus, real time evaluation of renal NIRS using the specific levels of change of a 20% reduction for 20 minutes may be useful in predicting prolonged mechanical ventilation and other adverse outcomes in children undergoing cardiac surgery.